Recognizing Hypoglycemia as a Public Health Issue
AADE recognizes the impact of serious hypoglycemic events as an important public health issue, leading to increased mortality and readmission rates for Medicare beneficiaries as well as a large economic burden on the system as a whole.
According to the 2016 Hypoglycemia Quality Collaborative Strategic Blueprint published by the Endocrine Society, patients and providers across the entire health care team lack the knowledge and tools to prevent and manage hypoglycemia – whether therapy-associated or spontaneous. Importantly, people with diabetes who suffer the worst outcomes are often lower socioeconomic status minorities who lack access to the system and have lower health literacy.
AADE joined other stakeholders to discuss and define clinically relevant outcomes beyond hemoglobin A1c in the Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report. This report provides a new evidence-based, consensus definition of hypoglycemia, including levels of hypoglycemia and their related glycemic criteria. Additionally, signs and symptoms of hypoglycemia at each level are discussed.
Glucose < 70 mg/dL (3.9 mmol/L) and Glucose ≥ 54 mg/dL (3.0 mmol/L)
Glucose < 54 mg/dL (<3.0 mmol/L)
A severe event characterized by altered mental and/or physical status requiring assistance
AADE was also represented by Mary Julius, LD, CDE, RDN of the Louis Stokes Cleveland VA at a key FDA event on mitigation of hypoglycemia, “Reducing the Risk of Preventable Adverse Drug Events associated with Hypoglycemia in the Older Population.” A free CE webinar for healthcare providers based on the work of that group is listed below.
Over the course of 2018, AADE will be finalizing an integrative review on hypoglycemia and creating a new series of resources around this important topic to ensure its members, via grassroots advocacy programs in the State Coordinating Bodies (CBs), have the tools and resources they need to advocate that important hypoglycemia awareness and risk reduction issues are reflected in state-level Diabetes Action Plan legislation.
Resources Currently Available:
- 2016 Hypoglycemia Quality Collaborative Strategic Blueprint
- Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF, International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange (Diabetes Care 2017;40:1622–1630)
- Free 1-Hour CE Opportunity Provided by the FDA: Leveraging Health Literacy and Patient Preferences to Reduce Hypoglycemic Events in Patients with Type 2 Diabetes
Conducted in November 2016, this is the third survey in a series of studies performed by AADE, designed to assess the impact of the DME Competitive Bidding program on beneficiary access to diabetes blood glucose test systems.Suppliers who were awarded contracts under the NMO recompete were surveyed. Results showed that the mix of brands of diabetes testing supplies carried by national mail order suppliers continues to decline, showing a nearly 50 percent reduction since it was first implemented in 2009.
As technical assistance for the Together on Diabetes initiative funded by the Bristol Myers Squibb Foundation, AADE requested a DSME cost-sharing white paper from the Harvard Law School. The white paper, Reconsidering Cost-Sharing For Diabetes Self-Management Education: Recommendation For Policy Reform, draws the conclusion that insurers should provide coverage of DSME with little or no cost-sharing in order to both improve patient health and curb costs.
In the fall of 2014 members of the American Association of Diabetes Educators conducted a study to assess the performance of the competitive bidding program (CBP) for insulin pumps and replacement supplies, and Medicare beneficiary access to insulin pumps and related supplies in competitive bidding areas. The results of this study found that many contract suppliers in each of the competitive bidding areas (CBAs) do not carry insulin pumps and/or related supplies. Read the complete study.
Conducted in October 2014, an in-depth analysis of the 578 comments received by the Food and Drug Administration (FDA) on draft guidance for blood glucose monitoring systems for over-the-counter use and prescription point-of-care use. This analysis was conducted in order to gain an accurate representation of the true feedback provided to the FDA on this issues.
Conducted in November 2013, a survey by Harris Interactive explored the opinions of people in the U.S. who have diabetes and use blood glucose meters. The research was intended to examine their knowledge and experiences with blood glucose meters and its role in the proper management of their condition. Attached is the executive summary.
A follow-up to a study conducted in August 2011 where diabetes educators surveyed contract suppliers to determine the range of products offered and the accuracy of information supplied by CMS via its website, Medicare.gov. Through that study, AADE found that contract suppliers in Round 1 were not offering most of the products said to be offered on Medicare.gov, and most of the products available to Medicare beneficiaries before implementation of Round 1 were no longer available to through the Competitive Bidding Program. In September 2013, AADE repeated the study, seeking to determine the range of diabetes testing supplies offered by contract suppliers to Medicare beneficiaries. Attached is the executive summary. Read the complete study from August 2011.
On October 1, 2013, Health Insurance Marketplaces nationwide will begin open enrollment. AADE has developed a brochure for diabetes educators and their patients with information on healthcare changes created by the implementation of Health Insurance Marketplaces. This document includes basic information for Health Insurance Marketplaces, a summary of “essential health benefits” and what patients with diabetes can expect to change in their healthcare coverage.
Recent studies provide additional compelling evidence that DSMT programs, involving a health team approach that includes Credentialed Diabetes Educators, not only significantly reduces overall health costs but also improves health outcomes.
These findings support the critical need for Congress to enact legislation to include Credentialed Diabetes Educators as Medicare providers of DSMT, in order to enhance access to DSMT care that directly impacts diabetes health outcomes and saves money.
AADE can provide you with valuable information and fact sheets to help you communicate to your Members of Congress the need and justification for the Credentialed Diabetes Educator to be recognized as a Medicare DSMT provider.
Dobson DaVanzo & Associates, LLC (Dobson | DaVanzo) was commissioned by AADE to estimate the financial impact of implementing H.R. 2787 using the Congressional Budget Office (CBO) scoring methodology. The proposed legislation designates credentialed diabetes educators as Medicare providers of Diabetes Self-Management Training (DSMT). Currently, DSMT programs must be accredited, and operate as distinct entities within a facility, such as a hospital. The DSMT benefit is thought to be underutilized, and many individuals living with diabetes lack access to a DSMT program. Medicare recognition of qualified diabetes educators as DSMT providers would promote quality and better access to care for diabetes education. Read the complete study.
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